title: Non-pharmacologic interventions to improve the sleep of hospitalized patients: a systematic review.
abstract: OBJECTIVE
  Despite the known adverse effects of sleep deprivation on recovery from illness, studies have shown that sleep deprivation remains an incompletely addressed problem among acutely ill inpatients. Behavioral interventions are recommended as first-line therapy prior to using pharmacologic therapy due to the side effects of sedative hypnotics. The objective of this systematic review was to identify non-pharmacologic interventions that have been used to improve sleep quality and quantity of non-intensive care unit (ICU) inpatients.
  
  
  METHODS
  PubMed, Embase, Web of Science, CINAHL, and Cochrane Library through January 2013; manual searches of reference lists.
  Any study in which a non-pharmacologic intervention was conducted in a general inpatient setting, and nighttime sleep quantity or quality was assessed.
  
  
  METHODS
  Information on study design, populations, interventions, comparators, outcomes, time frame, and risk of bias were independently abstracted by two investigators.
  
  
  RESULTS
  13 intervention studies with 1,154 participants were included. Four studies were randomized controlled trials. Seven studies had a low to medium risk of bias, and there was significant heterogeneity in the interventions. Relaxation techniques improved sleep quality 0-38%, interventions to improve sleep hygiene or reduce sleep interruptions improved sleep quantity 5%, and daytime bright light exposure improved sleep quantity 7-18%.
  
  
  CONCLUSIONS
  The heterogeneity in the types and dose of interventions, outcome measures, length of follow-up, differences in patient populations, and dearth of randomized trials may dilute effects seen or make it more difficult to draw conclusions.
  
  
  CONCLUSIONS
  There is insufficient to low strength of evidence that any non-pharmacologic intervention improves sleep quality or quantity of general inpatients. Further studies are needed in this area to guide clinicians.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E. Monument St, Suite 1-500W, Baltimore, MD, 21287, USA, rtamrat1@jhmi.edu.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tamrat
authors.forename: Minh-Phuong
authors.initials: MP
authors.lastname: Huynh-Le
authors.forename: Madhav
authors.initials: M
authors.lastname: Goyal
mesh_terms: D006760:Hospitalization; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012064:Relaxation Therapy / Q000379:methods; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*